ORGINAL ARTICLE
Some immediate serious complications of obstetric epidural analgesia and anaesthesia: a prospective study of 145 550 epidurals☆

https://doi.org/10.1016/j.ijoa.2004.07.009Get rights and content

Background:

Inadvertent intravascular, intrathecal or subdural injection in obstetric regional analgesia are potentially life-threatening, so following a catastrophic complication it was decided to collect data regionally.

Method:

Obstetric anaesthetists from 14, later 12 maternity units in the South West Thames Region collected and pooled data on obstetric anaesthetic interventions and complications from 1987 to 2003.

Results:

During the 17-year period, 145 550 epidurals (26.3%) were administered to 553 905 mothers. The incidence of intravascular injection was 1 in 5000 epidurals (0.02% [95%CI 0.014-0.029%]), of intrathecal injection 1 in 2900 epidurals (0.035% [95%CI 0.027-0.046%]), of subdural injection 1 in 4200 epidurals (0.024% [95%CI 0.017-0.033%]) and of high or total spinal block 1 in 16 200 epidurals (0.006% [95%CI 0.003-0.012%]). The incidence of serious complications did not change during the course of the study, nor was there any difference in the incidence of serious complications in obstetric units of different sizes or in obstetric units with different rates of epidural analgesia.

Conclusion:

The incidence of intravascular, intrathecal and subdural injection and of high or total spinal block was similar to that found in previous prospective studies in obstetric and non-obstetric patients. The incidence of these complications has not changed and is not related to the number of deliveries or the epidural rate in obstetric units.

Introduction

Lumbar epidural block provides safe obstetric analgesia and anaesthesia, but inadvertent intravascular, intrathecal or subdural injection are potentially life-threatening. There have been four maternal deaths due to high spinal block reported in the Confidential Enquiries into Maternal Deaths in the United Kingdom, between 1982 and 1999.[1], [2], [3], [4] We present data on the incidence of these immediate serious complications of obstetric epidural analgesia and anaesthesia, for the period 1987 to 2003, in the South West Thames (SWT) region. This relatively affluent region of the UK, which stretches from south-west London to the south coast of England, has a mainly urban population of over three million and there are approximately 37 000 deliveries each year.

Section snippets

Methods

For some years, following a catastrophic complication of obstetric epidural analgesia,5 obstetric anaesthetists in the SWT region, representing one teaching and originally 13, now 11, district general hospital maternity units, have collected data on obstetric anaesthetic interventions. These data are gathered locally either from paper records or using a FileMaker Pro database developed specifically for this purpose, on PC or Macintosh computers, and are then collated annually. We have data on

Results

There are complete data for 205 out of a possible 228 hospital years (90%) for the period 1987-2003. During this 17-year period 553 905 mothers were delivered and 145 550 (26.3%) epidurals were administered for analgesia or anaesthesia. The mean epidural rate with range and trendline from 1987 to 2003 is shown in Fig. 1. The epidural rate rose from 21.8% in 1987 to a high of 34.7% in 2000 falling to 27.4% in 2003. The numbers and incidence of intravascular injection, intrathecal injection,

Discussion

There have been several studies on the complications of obstetric epidural analgesia and anaesthesia. Some of these have been retrospective, either postal surveys[13], [14] or analysis of insurance claims,15 whilst others have been prospective studies from single units.[6], [16], [17], [18] There has been only one previous prospective multicentre study of the complications of obstetric blockade, a two year study in over 70 units in the UK.19 A summary of our findings and those of previous

References (21)

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☆

The South West Thames Regional Obstetric Anaesthetic Audit Project involves obstetric anaesthetists from Crawley, East Surrey, Epsom, Frimley Park, Kingston, Mayday, Princess Royal, Queen Mary’s, Royal Surrey County, St George’s, St Helier, St Peter’s, St Richard’s and Worthing Hospitals.

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